Insurance coverage for revision?

[Bandedbut 25]

I've been banded 2 1/2 years. The first year was great. Found that sweet spot on the second fill. When I was 5-10 pounds away from goal, I started having problems. I was unfilled, and the battle began. I haven't been able to get that sweet spot again, and have constant problems with back aches, heart burn, acid reflux, former banders, you have all been there. In the short time I was unfilled completely, I gained back about 20 pounds. I've since lost that, but am sick of all this. I currently most likely have an expanded pouch yet AGAIN.

The problem is that I was self pay, and insurance isn't even covering unfills due to dehydration (twice, yet they pay to have me go to urgent care and get 3 bags of fluids in me). What conditions will insurance pay for removal (and then a revision to a sleeve). I'm afraid to just get the band removed, I know I would gain everything back, but not sure if insurance would approve doing the sleeve at the same time since I am so close to my goal.

The quality of life at this point is getting very frustrating. I can't eat healthy foods, and I can't even get in to a routine since one day I'm fine, then the next I'm throwing up an antacid tablet.

[Oregondaisy 2,020]

It just amazes me that insurance companies are willing to pay for banding at all with all the problems people are having.

I feel bad for you, but I wanted that band out of me bad enough that I self paid. It was the best money I could have spent.

[TennJenn 9]

I don't have experience with this, but in my research I have come across many self pay banded patients who end up having to self pay for band removal. You might get your insurance company to cover it, but I feel the odds are stacked against you. Have you contacted them to ask if there are certian medical situations in which they would pay to have your band removed? Another thing is if they didn't cover your band, I doubt they would cover a revision.

Why did you end up being self pay for the band?

[MacMadame 81]

It completely depends on your insurance company and the policy you have with them.

Some won't pay for sleeves under any circumstances. Some will pay for them for a revision, but not for a virgin sleeve. Some will pay no matter your BMI -- you only have to show you were compliant with the program and your WLS failed for reasons not under your control (like a band slipping or eroding). Others want you to re-qualify for the surgery (i.e., have a high enough BMI).

If you self-payed before because WLS wasn't covered under your insurance and you have the same insurance, they absolutely won't pay to remove the band and won't pay for the new WLS.

If you now have insurance that covers WLS, then they should pay for band removal, but they may or may not pay for a revision to a new surgery depending on what their criteria is for revisions.

A lot of time, you can find their clinical policies on their web sites and then you can read the criteria for yourself.

[Bandedbut 25]

Thanks MacMadame, I never thought to look on their website. Going through VM hell (especially if it can only be done during work hours where I work in a cube, and don't want that kind of conversation overheard) then talking to someone that doesn't have a clue or, me not understanding the medical technology discourages me.

I was self pay because, while my insurance DOES cover WLS, my BMI wasn't high enough to qualify. But I could see the direction I was headed, and after a lifetime of dieting only to gain it all back, why wait until I did qualify. I was told at the time, that if I had complications, and needed it removed, that insurance WOULD cover it. I assume that is if it is medically necessary, not just because I want it out.

I don't have problems with the band when it is unfilled, but obviously then it isn't doing much either. From experience, I know that unfilled=weight gain. We've had a tough year financially, right now, I literally don't even have the money for a fill/unfill so there is no possible way I could pay for a surgery. That is what is so frustrating, I can't afford to play around with the fills to find the right spot! The sleeve just sounds so much easier. Unfortunately, I had never heard of it when I was banded.

[Oregondaisy 2,020]

I had never heard of it either. I could have saved myself 10 grand. I would have never found out about the sleeve though, if it were not for lap band talk. So it all worked out.

[TexasT 99]

This is my first post on the forum, so here goes. I got a band March 2006 and was self-pay. I'm scheduled to have a revision to VSG on October 30th with my original lapband surgeon. I went to him for a checkup because of abdominal pain. After an abdominal ultrasound it was found that I have gallstones. After discussing my band "issues", he suggested we do the sleeve.

My insurance will pay for gallbladder removal, so we're going to do it all in the same procedure. I will pay $5000 for the band removal and VSG. This is much less than most revision surgeries since the insurance is already paying for the hospital, anesthesia, etc. I know this is not the way to go about it for most people, but it is something to consider if you have gallbladder issues and your insurance will cover removing it.

Good luck!

[bostermax 0]

Statutory coverage is a Disability Benefits policy that covers all employees eligible under the Disability Benefits Law, provides the same benefits in all respects as provided under Section 204 and requires employee contributions not in excess of those authorized under Section 209.

[4re4me 1]

Hey All,

My insurance Co., Aetna Health Care has approved the cost of removing my band but NOT the sleeve revision. My Dr says he can perform the procedure at the same time. Price will be $8000 for hospital and $1736 for his fee. Total $9736.

I asked about a discount as it seems my insurance company is already paying for hospital, surgeon, anthestiga, etc. They are telling me no because it is two different procedures even though performed in in the same operation. Has anybody else run into this?? I expect to cover the cost difference and I am sure there are some but this really sounds like I am being double dipped. If anyone else has had this situation what was your out of pocket expenses?